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Levene I, O'Brien F, Fewtrell M, Quigley MA. The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study. MATERNAL & CHILD NUTRITION 2024:e13719. [PMID: 39239700 DOI: 10.1111/mcn.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/18/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500-750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24-h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post-menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3-4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3-5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | | | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
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Hilditch C, Collins CT, Rumbold A, Gomersall J, Middleton P, Keir A. Breastmilk use in preterm infants <29 weeks' gestational age in Australia, New Zealand and Singapore. J Paediatr Child Health 2024. [PMID: 39233502 DOI: 10.1111/jpc.16656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/18/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
AIMS To describe the prevalence of use of breastmilk and explore demographic characteristics and clinical outcomes associated with breastmilk provision in infants born <29 weeks' gestational age in Australia, New Zealand and Singapore. METHODS This is a secondary analysis of data from a randomised controlled trial, which enrolled 1273 infants in 13 neonatal units across Australia, New Zealand and Singapore from 2012 to 2015. Infants were classified as formula-fed, donor milk-fed or mother's milk-fed at their first enteral feed and separately, at hospital discharge. RESULTS The percentage of infants receiving mother's own milk differed between centres both at first feed (79% to 100%), and at hospital discharge (47.1% to 71.6%). Aboriginal, Torres Strait Islander and Southeast Asian heritage, drug use and smoking were associated with lower rates of fully breastmilk feeding at hospital discharge. There was no significant difference in growth outcomes, length of stay and feeding tolerance between feeding groups. CONCLUSIONS Achieving high breastmilk feeding rates at hospital discharge for all preterm infants born <29 weeks' gestational age at hospital discharge is possible; however, targeted support for mothers who are Indigenous, Southeast Asian and/or using recreational drugs and/or smoking and/or experiencing social disadvantage may be needed. A better understanding and shared knowledge of practice variations within neonatal units with high breastfeeding rates could improve breastmilk access and equity for preterm infants. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY ACTRN12612000503820.
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Affiliation(s)
- Cathie Hilditch
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alice Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Judith Gomersall
- School of Public Health, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Keir
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Children's Health Network, North Adelaide, South Australia, Australia
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Levene I, Quigley MA, Fewtrell M, O'Brien F. Does extremely early expression of colostrum after very preterm birth improve mother's own milk quantity? A cohort study. Arch Dis Child Fetal Neonatal Ed 2024; 109:475-480. [PMID: 38442953 PMCID: PMC11347236 DOI: 10.1136/archdischild-2023-326784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Assess the relationship of time to first expression after very preterm birth and mothers' own milk quantity. DESIGN A cohort study (nested within a randomised trial). SETTING Four neonatal units in the UK. PATIENTS 132 mothers of single or twin infants born at 23+0 to 31+6 weeks postmenstrual age. EXPOSURES Time to the first attempt to express after birth. PRIMARY OUTCOMES 24-hour mother's own milk yield on days 4, 14 and 21 after birth. RESULTS Median time to first expression attempt was 6 hours. 51.7% expressed within 6 hours of birth (62/120) and 48.3% expressed more than 6 hours after birth (58/120). Expressing within 6 hours of birth was associated with higher milk yield on day 4 (88.3 g, 95% CI 7.1 to 169.4) and day 14 (155.7 g, 95% CI 12.2 to 299.3) but not on day 21 (73.6 g, 95% CI -91.4 to 238.7). There was an interaction between expressing frequency and time to first expression (p<0.005), with increased expressing frequency being associated with higher yield only in those who expressed within 6 hours. Expressing within 2 hours of birth was not associated with further milk yield increase. CONCLUSIONS Mothers who expressed within 6 hours of birth had higher milk yield, and a greater yield per expressing session, in the first 3 weeks after birth. This information will be highly motivating for families and the clinicians supporting them. There was no evidence of further benefit of extremely early expression (first 2 hours after birth). TRIAL REGISTRATION NUMBER ISRCTN 16356650.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Frances O'Brien
- Neonatal Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK
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Berg A, Rani U, Colaizy T, Smith A, Evans J, Murad MH, Bhutta ZA, Imdad A. The impact of donating milk on the health of milk donors and their infants: A systematic review and meta-analysis protocol. JPGN REPORTS 2024; 5:347-352. [PMID: 39149172 PMCID: PMC11322006 DOI: 10.1002/jpr3.12101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 08/17/2024]
Abstract
Objectives Breast milk is the recommended nutritional source for newborns and has been associated with decreased morbidity in low-birth-weight and preterm infants. In situations where breast milk is not available, donor breast milk is an alternative. Milk banking is becoming increasingly common worldwide to meet this need. Although the benefits of donor breast milk for the recipient infant are well established, the health impact on the breast milk donor and the infant of the breast milk donor is an area of current research. We aim to synthesize and evaluate the available evidence regarding the impact of donating breast milk on the health, lactation, and well-being of the breast milk donor, and the health and growth of the infant of the breast milk donor. Methods We will search electronic databases, grey literature, and the websites of relevant international organizations. We will include studies that involve lactating women and their infants, healthy or with health conditions, who donate breast milk, without restrictions on study date, language, or study design. If sufficient homogeneity exists between studies, we will complete meta-analyses. We will evaluate the risk of bias using the Risk of Bias tool or the Cochrane Risk of Bias in Non-Randomized Studies tool. We will evaluate the overall certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Conclusion In this systematic review and meta-analysis, we will summarize the current literature regarding the effects of human milk donation on human milk donors and their infants.
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Affiliation(s)
- Alaina Berg
- The University of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Uzma Rani
- Stead Family Department of Pediatrics, Division of NeonatologyUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Tarah Colaizy
- Stead Family Department of Pediatrics, Division of General PediatricsUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Abigail Smith
- Health Sciences LibraryState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
| | - James Evans
- Health Sciences LibraryState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
| | - Mohammad H. Murad
- Department of Internal Medicine, Division of Preventive, Occupational and Aerospace MedicineMayo ClinicRochesterMinnesotaUSA
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthHospital for Sick ChildrenTorontoOntarioCanada
- Centre of Excellence in Women and Child HealthAga Khan UniversityKarachiPakistan
- Institute for Global Health and DevelopmentAga Khan UniversityKarachiPakistan
- Department of Nutrition, Joannah and Brian Lawson Centre for Child NutritionUniversity of TorontoTorontoOntarioCanada
| | - Aamer Imdad
- Stead Family Department of Pediatrics, Division of Gastroenterology, Hepatology, Pancreatology, and NutritionUniversity of IowaIowa CityIowaUSA
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Levene I, Fewtrell M, Quigley MA, O'Brien F. The relationship of milk expression pattern and lactation outcomes after very premature birth: A cohort study. PLoS One 2024; 19:e0307522. [PMID: 39074108 DOI: 10.1371/journal.pone.0307522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/07/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Mothers of very premature infants often have difficulties expressing breastmilk, which can cause distress and potential negative impact on infant health. Clinical recommendations on breastmilk expression are extrapolated from term infants' breastfeeding patterns. This study's objective was to analyse the association of expressing pattern with lactation outcomes after very premature birth. METHODS 132 participants were recruited after birth between 23+0 and 31+6 weeks' gestation. Participants recorded the milk expressed in several 24-hour periods in the three weeks after birth. RESULTS Expressing frequency was positively associated with 24-hour milk yield, with an adjusted 30.5g increase per expressing session on day four (95% CI 15.7 to 45.3) and 94.4g on day 21 (95% CI 62.7 to 126.2). Expressing ≥8 times per day was associated with higher adjusted milk yield than expressing <6 times (on day four, 146.8g, 95% CI 47.4 to 246.1), but not in comparison to expressing 6-7 times (on day four, 82.1g, 95% CI -25.9 to 190.1). Participants with six months or more prior breastmilk feeding experience had a higher adjusted milk yield than others (on day four, 204.3g, 95% CI 125.2 to 283.3). Night-time (2300-0700 hours) expressing sessions were not associated with increased milk yield after adjustment for time since the prior session. On average, participants who had a longest gap between expressions of less than six hours achieved the UK target of 750g breastmilk, whereas those with a longer gap did not. CONCLUSION Expressing frequency was an important determinant of milk yield. Clinical recommendations to express ≥8 times per day were supported but for some, 6-7 times was sufficient. This was particularly likely for those with six months or more of prior breastmilk feeding experience. A need to express during the night-time hours appeared to be related to minimising the gap between expressions rather than an inherent value of night-time expression.
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Affiliation(s)
- Ilana Levene
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Mary Fewtrell
- Institute of Child Health, University College London, London, United Kingdom
| | - Maria A Quigley
- Nuffield Department of Public Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Frances O'Brien
- Newborn Care, John Radcliffe Hospital, Oxford, United Kingdom
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Quitadamo PA, Zambianco F, Palumbo G, Wagner X, Gentile MA, Mondelli A. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review. Foods 2024; 13:649. [PMID: 38472762 DOI: 10.3390/foods13050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 03/14/2024] Open
Abstract
Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milan, MI, Italy
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Xavier Wagner
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Université Paris Cité, 79279 Paris, France
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
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Prasad M, Ingolfsland EC, Christiansen SP. Modifiable Risk Factors and Preventative Strategies for Severe Retinopathy of Prematurity. Life (Basel) 2023; 13:life13051075. [PMID: 37240719 DOI: 10.3390/life13051075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/28/2023] Open
Abstract
Severe ROP is characterized by the development of retinal fibrovascular proliferation that may progress to retinal detachment. The purpose of this report is to review five of the most common and well-studied perinatal and neonatal modifiable risk factors for the development of severe ROP. Hyperoxemia, hypoxia, and associated prolonged respiratory support are linked to the development of severe ROP. While there is a well-established association between clinical maternal chorioamnionitis and severe ROP, there is greater variability between histologic chorioamnionitis and severe ROP. Neonatal sepsis, including both bacterial and fungal subtypes, are independent predictors of severe ROP in preterm infants. Although there is limited evidence related to platelet transfusions, the risk of severe ROP increases with the number and volume of red blood cell transfusions. Poor postnatal weight gain within the first six weeks of life is also strongly tied to the development of severe ROP. We also discuss preventative strategies that may reduce the risk of severe ROP. Limited evidence-based studies exist regarding the protective effects of caffeine, human milk, and vitamins A and E.
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Affiliation(s)
- Minali Prasad
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Ellen C Ingolfsland
- Department of Pediatrics, Division of Neonatology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stephen P Christiansen
- Departments of Ophthalmology and Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Trabulsi JC, Lessen R, Siemienski K, Delahanty MT, Rickman R, Papas MA, Rovner A. Relationship Between Human Milk Feeding Patterns and Growth in the First Year of Life in Infants with Congenital Heart Defects. Pediatr Cardiol 2023; 44:882-891. [PMID: 36282285 DOI: 10.1007/s00246-022-03023-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/03/2022] [Indexed: 10/31/2022]
Abstract
The purpose of this study was to determine the relationship between patterning of human milk feeding and growth of infants with congenital heart defects in the first year of life. Inclusion criteria for this prospective cohort study included infants 0-21 days, who had undergone or had planned neonatal corrective or palliative surgery prior to hospital discharge, and whose mothers planned to feed human milk. Data on anthropometric measures (weight, length, head circumference) and infant milk type (human milk, formula, other) were collected at nine time points (0.5, 1, 2, 3, 4, 6, 8, 10, 12 months). Anthropometric data were converted to weight-for-age, length-for-age, head circumference-for-age, and weight-for-length Z-scores using World Health Organization growth reference data. Cluster analysis identified three milk type feeding patterns in the first year: Infants fed human milk only with no formula supplementation, infants fed human milk who then transitioned to a mix of human milk and formula, and infants who fed human milk and transitioned to formula only. General linear models assessed the effect of milk type feeding patterns on growth parameters over time. No effect of milk type pattern × time was found on longitudinal changes in weight-for-age (p for interaction = 0.228), length-for-age (p for interaction = 0.173), weight-for-length (p for interaction = 0.507), or head circumference-for-age (p for interaction = 0.311) Z-scores. In this cohort study, human milk alone or combined with infant formula supported age-appropriate growth in infants with congenital heart defects in the first year.
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Affiliation(s)
- Jillian C Trabulsi
- Department of Behavioral Health and Nutrition, University of Delaware, 318 STAR Tower, 100 Discovery Blvd., Newark, DE, 19713, USA.
| | - Rachelle Lessen
- Lactation Department, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Kathryn Siemienski
- Clinical Nutrition, Christiana Care, Avenue North, 4000 Nexus Drive, Wilmington, DE, 19803, USA
| | - Michelle T Delahanty
- Department of Behavioral Health and Nutrition, University of Delaware, 318 STAR Tower, 100 Discovery Blvd., Newark, DE, 19713, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Texas - Austin, Austin, TX, 78705, USA
| | - Mia A Papas
- Institute for Research on Equity and Community Health, Christiana Care, 4755 Ogletown-Stanton Road, Newark, DE, 19718, USA
| | - Alisha Rovner
- Department of Behavioral Health and Nutrition, University of Delaware, 318 STAR Tower, 100 Discovery Blvd., Newark, DE, 19713, USA
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Embleton ND, Sproat T, Uthaya S, Young GR, Garg S, Vasu V, Masi AC, Beck L, Modi N, Stewart CJ, Berrington JE. Effect of an Exclusive Human Milk Diet on the Gut Microbiome in Preterm Infants: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e231165. [PMID: 36857051 PMCID: PMC9978942 DOI: 10.1001/jamanetworkopen.2023.1165] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
IMPORTANCE The effect of using an exclusive human milk diet compared with one that uses bovine products in preterm infants is uncertain, but some studies demonstrate lower rates of key neonatal morbidities. A potential mediating pathway is the gut microbiome. OBJECTIVE To determine the effect of an exclusive human milk diet on gut bacterial richness, diversity, and proportions of specific taxa in preterm infants from enrollment to 34 weeks' postmenstrual age. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 4 neonatal intensive care units in the United Kingdom from 2017 to 2020, microbiome analyses were blind to group. Infants less than 30 weeks' gestation who had only received own mother's milk were recruited before 72 hours of age. Statistical analysis was performed from July 2019 to September 2021. INTERVENTIONS Exclusive human milk diet using pasteurized human milk for any shortfall in mother's own milk supply and human milk-derived fortifiers (intervention) compared with bovine formula and bovine-derived fortifier (control) until 34 weeks' postmenstrual age. Fortifier commenced less than 48 hours of tolerating 150 mL/kg per day. MAIN OUTCOMES AND MEASURES Gut microbiome profile including alpha and beta diversity, and presence of specific bacterial taxa. RESULTS Of 126 preterm infants enrolled in the study, 63 were randomized to control (median [IQR] gestation: 27.0 weeks [26.0-28.1 weeks]; median [IQR] birthweight: 910 g [704-1054 g]; 32 [51%] male) and 63 were randomized to intervention (median [IQR] gestation: 27.1 weeks [25.7-28.1 weeks]; median [IQR] birthweight: 930 g [733-1095 g]; 38 [60%] male); 472 stool samples from 116 infants were analyzed. There were no differences in bacterial richness or Shannon diversity over time, or at 34 weeks between trial groups. The exclusive human milk diet group had reduced relative abundance of Lactobacillus after adjustment for confounders (coefficient estimate, 0.056; P = .03), but not after false discovery rate adjustment. There were no differences in time to full feeds, necrotizing enterocolitis, or other key neonatal morbidities. CONCLUSIONS AND RELEVANCE In this randomized clinical trial in preterm infants using human milk-derived formula and/or fortifier to enable an exclusive human milk diet, there were no effects on overall measures of gut bacterial diversity but there were effects on specific bacterial taxa previously associated with human milk receipt. These findings suggest that the clinical impact of human milk-derived products is not modulated via microbiomic mechanisms. TRIAL REGISTRATION ISRCTN trial registry identifier: ISRCTN16799022.
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Affiliation(s)
- Nicholas D. Embleton
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Sproat
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sabita Uthaya
- Section of Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
| | | | - Shalabh Garg
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Vimal Vasu
- William Harvey Hospital, Ashford, Kent, United Kingdom
| | - Andrea C. Masi
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lauren Beck
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
| | - Christopher J. Stewart
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Janet E. Berrington
- Newcastle Hospitals NHS Trust, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Salvatori G, De Rose DU, Clemente M, Gentili C, Verardi GP, Amadio P, Reposi MP, Bagolan P, Dotta A. How much does a liter of donor human milk cost? Cost analysis of operating a human milk bank in Italy. Int Breastfeed J 2022; 17:90. [PMID: 36539788 PMCID: PMC9764658 DOI: 10.1186/s13006-022-00530-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To date, 40 Human Milk Banks (HMB) have been established in Italy; however, recent cost analysis data for operating an HMB in Italy are not available in the literature. METHODS This study was a cross-sectional study performed at "Bambino Gesù" Children's Hospital in Rome, Italy in 2019. We assessed the one-year operational costs and, the per liter unit costs at our HMB. RESULTS During the 2019 year we collected 771 l of human milk supplied by 128 donors. The total cost was € 178,287.00 and the average cost was € 231.00 per liter. € 188,716.00 would have been spent had the maximum capacity for 904 l been reached. We found a significant difference (€ 231.00 vs € 209.00 per liter, p = 0.016) comparing the cost for collected liters in the year 2019 and the cost for the maximum capacity of the bank for that year of activity. Analyzing each cost item that determines the charge of donor human milk (DHM), the highest costs are the salaries of medical and paramedical staff, and then the costs related to transporting. If the HMB works at maximum capacity and manages a greater number of liters of milk, this can represent an important saving. Conversely, the price of consumables is modest (i.e., the price of a single-use kit for breast pumps was € 0.22 per unit). CONCLUSION The costs for a liter of DHM are quite high, but they must be related to the benefits, especially for preterm infants. Comparing the cost for collected liters in 2019 and the costs for the 2019 maximum capacity of the HMB, we calculated how much fixed costs of collection and distribution of DHM can be reduced, by increasing the volume of milk collected. To the best of our knowledge, this is the first complete cost analysis for an Italian Milk Bank. A thorough analysis could help to abate fixed costs and reduce the cost of a liter of DHM. The centralization of DHM can allow savings, rather than creating small HMBs scattered throughout the territory that would operate with lower milk volumes.
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Affiliation(s)
- Guglielmo Salvatori
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit and Human Milk Bank, Department of Life and Reproductive Sciences, Verona Hospital, Verona, Italy
| | - Cristina Gentili
- grid.414125.70000 0001 0727 6809Finance Control, Internal Control, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Giovanni Paride Verardi
- grid.414125.70000 0001 0727 6809Finance Control, Internal Control, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Patrizia Amadio
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Maria Paola Reposi
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
| | - Pietro Bagolan
- grid.414125.70000 0001 0727 6809Neonatal Surgery Unit, Medical and Surgical Department of Fetus - Newborn – Infant, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- grid.414125.70000 0001 0727 6809Neonatal Intensive Care Unit and Human Milk Bank, Medical and Surgical Department of Fetus - Newborn – Infant, “Bambino Gesù” Children’s Hospital IRCCS, Rome, Italy
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Differences in Neonatal Outcomes Among Premature Infants Exposed to Mother's Own Milk Versus Donor Human Milk. Adv Neonatal Care 2022; 22:539-549. [PMID: 35939792 DOI: 10.1097/anc.0000000000001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Growing evidence supports the superior benefits of exposure to mother's own milk (MOM) in reducing prematurity-related comorbidities. Neonatal exposure to donor human Milk (DHM) is a suitable alternative when MOM is insufficient or unavailable. However, the same protective composition and bioactivity in MOM are not present in DHM. Additional evidence is needed to justify and inform evidence-based practices increasing MOM provision while optimizing adequate use of DHM for premature infants. PURPOSE A systematic review of the literature was conducted to determine differences in neonatal outcomes among premature infants exposed to predominately MOM versus DHM. METHODS/SEARCH STRATEGY Databases including PubMed, CINAHL and Cochrane were searched (2020-2021) using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Evidence was classified using the John Hopkins evidence-based practice levels and quality of evidence. RESULTS Eleven studies met inclusion criteria. Studied neonatal outcomes included ( a ) growth parameters (n = 8), ( b ) neonatal morbidities (n = 6), and ( c ) gut microbiome (n = 4). Overall, evidence suggests DHM exposure is beneficial but not equivalent to MOM feeding. Compared with DHM, greater doses of MOM are ideal to enhance protection primarily related to infant growth, as well as gut microbiome diversity and richness. IMPLICATIONS FOR PRACTICE Standardized and evidence-based practices are needed to clearly delineate optimal use of DHM without undermining maternal and neonatal staff efforts to support and promote provision of MOM. IMPLICATIONS FOR RESEARCH Additional evidence from high-quality studies should further examine differences in neonatal outcomes among infants exposed to predominately MOM or DHM in settings using standardized and evidence-based feeding practices.
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Peng W, Han J, Li S, Zhang L, Yang C, Guo J, Cao Y. The Association of Human Milk Feeding With Short-Term Health Outcomes Among Chinese Very/Extremely Low Birth Weight Infants. J Hum Lact 2022; 38:670-677. [PMID: 35236170 DOI: 10.1177/08903344221078237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is limited evidence about the influence of human milk feeding on short-term outcomes in a large preterm infant population. RESEARCH AIMS To explore the influences of human milk feeding on the primary outcome of necrotizing enterocolitis and secondarily sepsis, bronchial pulmonary dysplasia, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding at discharge in very/extremely low-birth-weight infants. METHODS This study was a retrospective, longitudinal, observational two-group comparison cohort study. A total of 4470 very/extremely low-birth-weight infants from 25 neonatal intensive care units in China, between April 2015 and May 2018, were enrolled in this study. Exclusive human milk-fed and formula-fed participants were matched using propensity scores. After matching, human milk-fed participants (n = 1379) and formula-fed participants (n = 1378) were included in the analyses. The likelihood of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding were compared between the two groups. RESULTS Exclusive human milk feeding was associated with lower odds of necrotizing enterocolitis (2.90% vs. 8.42%, OR 0.33, 95% CI [0.22, 0.47]), bronchopulmonary dysplasia (15.74% vs. 20.26%, OR 0.69, 95% CI [0.56, 0.86]), severe retinopathy of prematurity (1.45% vs. 2.39%, OR 0.50, 95% CI [0.27, 0.93]), and death (6.02% vs. 10.38%, OR 0.44, 95% CI [0.32, 0.61]) compared with formula feeding. No significant differences in the time to achieve full enteral feeding or the odds of sepsis were found between the two groups. CONCLUSION Exclusive human milk feeding is associated with a reduction in necrotizing enterocolitis, bronchopulmonary dysplasia, severe retinopathy of prematurity, and mortality among very/extremely low-birth-weight infants. TRIAL REGISTRATION Clinicaltrials.gov on November 9, 2015 (NCT02600195).
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Affiliation(s)
- Wenjing Peng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Junyan Han
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Shujuan Li
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chuanzhong Yang
- The Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University, Shanghai, China
| | - Jinzhen Guo
- Northwest Women and Children's Hospital, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,National Health Commission (NHC) Key Laboratory of Neonatal Diseases (Fudan University), Shanghai, China
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Yao Q, Gao Y, Fan L, Wang J, Zheng N. 2'-Fucosyllactose Remits Colitis-Induced Liver Oxygen Stress through the Gut-Liver-Metabolites Axis. Nutrients 2022; 14:nu14194186. [PMID: 36235838 PMCID: PMC9572607 DOI: 10.3390/nu14194186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Liver oxygen stress is one of the main extraintestinal manifestations of colitis and 5% of cases develop into a further liver injury and metabolic disease. 2′-fucosyllactose (2′-FL), a main member of human milk oligosaccharides (HMOs), has been found to exert efficient impacts on remitting colitis. However, whether 2′-FL exerts the function to alleviate colitis-induced liver injury and how 2′-FL influences the metabolism via regulating gut microbiota remain unknown. Herein, in our study, liver oxygen stress was measured by measuring liver weight and oxygen-stress-related indicators. Then, 16S full-length sequencing analysis and non-target metabolome in feces were performed to evaluate the overall responses of metabolites and intestinal bacteria after being treated with 2′-FL (400 mg/kg b.w.) in colitis mice. The results showed that, compared with the control group, the liver weight of colitis mice was significantly decreased by 18.30% (p < 0.05). After 2′-FL treatment, the liver weight was significantly increased by 12.65% compared with colitis mice (p < 0.05). Meanwhile, they exhibited higher levels of oxidation in liver tissue with decreasing total antioxidant capacity (T-AOC) (decreased by 17.15%) and glutathione (GSH) levels (dropped by 22.68%) and an increasing malondialdehyde (MDA) level (increased by 36.24%), and 2′-FL treatment could reverse those tendencies. Full-length 16S rRNA sequencing revealed that there were 39 species/genera differentially enriched in the control, dextran sulphate sodium (DSS), and DSS + 2′-FL groups. After treatment with 2′-FL, the intestinal metabolic patterns, especially glycometabolism and the lipid-metabolism-related process, in DSS mice were strikingly altered with 33 metabolites significantly down-regulated and 26 metabolites up-regulated. Further analysis found DSS induced a 40.01%, 41.12%, 43.81%, and 39.86% decline in acetic acid, propionic acid, butyric acid, and total short chain fatty acids (SCFAs) in colitis mice (all p < 0.05), respectively, while these were up-regulated to different degrees in the DSS + 2′-FL group. By co-analyzing the data of gut microbiota and metabolites, glycometabolism and lipid-metabolism-associated metabolites exhibited strong positive/negative relationships with Akkermansia_muciniphila (all p < 0.01) and Paraprevotella spp. (all p < 0.01), suggesting that the two species might play crucial roles in the process of 2′-FL alleviating colitis-induced liver oxygen stress. In conclusion, in the gut−liver−microbiotas axis, 2′-FL mediated in glucose and lipid-related metabolism and alleviated liver oxygen stress via regulating gut microbiota in the DSS-induced colitis model. The above results provide a new perspective to understand the probiotic function of 2′-FL.
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Affiliation(s)
- Qianqian Yao
- Key Laboratory of Quality & Safety Control for Milk and Dairy Products of Ministry of Agriculture and Rural Affairs, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, 2# Yuanmingyuan West Road, Haidian District, Beijing 100193, China
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
- Gembloux Agro-Bio Tech, University of Liège, B-5030 Gembloux, Belgium
| | - Yanan Gao
- Key Laboratory of Quality & Safety Control for Milk and Dairy Products of Ministry of Agriculture and Rural Affairs, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, 2# Yuanmingyuan West Road, Haidian District, Beijing 100193, China
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Linlin Fan
- Key Laboratory of Quality & Safety Control for Milk and Dairy Products of Ministry of Agriculture and Rural Affairs, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, 2# Yuanmingyuan West Road, Haidian District, Beijing 100193, China
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Jiaqi Wang
- Key Laboratory of Quality & Safety Control for Milk and Dairy Products of Ministry of Agriculture and Rural Affairs, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, 2# Yuanmingyuan West Road, Haidian District, Beijing 100193, China
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
| | - Nan Zheng
- Key Laboratory of Quality & Safety Control for Milk and Dairy Products of Ministry of Agriculture and Rural Affairs, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, 2# Yuanmingyuan West Road, Haidian District, Beijing 100193, China
- State Key Laboratory of Animal Nutrition, Institute of Animal Sciences, Chinese Academy of Agricultural Sciences, Beijing 100193, China
- Correspondence: ; Tel.: +86-10-62816069; Fax: +86-10-62897587
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14
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Huang J, Zheng Z, Zhao X, Huang L, Wang L, Zhang X, Lin X. Short-term effects of fresh mother's own milk in very preterm infants. MATERNAL & CHILD NUTRITION 2022; 19:e13430. [PMID: 36098334 PMCID: PMC9749607 DOI: 10.1111/mcn.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Fresh mother's own milk (MOM) can protect preterm infants from many complications. Often MOM is pasteurized for safety, which can deactivate cellular and bioactive components with protective benefits. Questions remain regarding whether pasteurized MOM provides the same benefits as fresh MOM. The aim of this study was to evaluate the association and feasibility of feeding very preterm infants with fresh MOM. This prospective cohort study included 157 very preterm infants born before 32 weeks' gestational age and with a birthweight below 1500 g. Of these, 82 infants were included in the fresh MOM without any processing group and 75 infants were included in the pasteurized never-frozen MOM (PNFMOM) group. The mortality rate, survival rate without severe complication, incidence of complications, feeding indexes and growth velocities were compared to assess the association and feasibility of feeding fresh MOM. Compared with the PNFMOM group, the fresh MOM group had a higher survival rate without severe complications (p = 0.014) and a lower incidence of bronchopulmonary dysplasia (p = 0.010) after adjustment for confounders. The fresh MOM group regained birthweight earlier (p = 0.021), reached total enteral feeding earlier (p = 0.024), and received total parenteral nutrition for less time (p = 0.045). No adverse events associated with fresh MOM feeding were recorded. Feeding fresh MOM may reduce the incidence of complications in very premature infants. Fresh MOM was shown to be a feasible feeding strategy to improve preterm infants' outcomes.
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Affiliation(s)
- Jing Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Zhi Zheng
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐yan Zhao
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Li‐han Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Lian Wang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐lan Zhang
- Department of NeonatologyXiamen Humanity HospitalXiamenChina
| | - Xin‐zhu Lin
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
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15
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Effect of an exclusive human milk diet on feeding tolerance in preterm infants. J Perinatol 2022; 42:1070-1075. [PMID: 35184144 DOI: 10.1038/s41372-022-01348-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the time to full enteral feeds in preterm infants fed exclusive human milk (EHM) - mother's own milk (MOM) fortified with human milk-based fortifier (HMBF), to those who received partial human milk (PHM) - MOM fortified with bovine milk-based fortifier (BMBF), and exclusive formula. STUDY DESIGN A single-center retrospective study of infants with birth weight <1250 g from 2013 to 2018. Data on feeding, growth and other short-term neonatal morbidities were collected. RESULTS On regression analysis, time to full enteral feeds was significantly higher in PHM compared to EHM group (β-coefficient 4.14, 95% CI 0.00-8.29) and formula-fed group compared to EHM (β-coefficient 4.3, 95% CI 0.32-8.20). No significant differences in growth velocity, length of stay and other morbidities were found between the groups. CONCLUSION Infants in EHM had better feeding tolerance and reached their enteral feed goals sooner compared to PHM and formula-fed groups.
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Levene I, Bell JL, Cole C, Stanbury K, O'Brien F, Fewtrell M, Quigley MA. Comparing the effect of a lactation-specific relaxation and visualisation intervention versus standard care on lactation and mental health outcomes in mothers of very premature infants (the EXPRESS trial): study protocol for a multi-centre, unmasked, randomised, parallel-group trial. Trials 2022; 23:611. [PMID: 35906655 PMCID: PMC9335469 DOI: 10.1186/s13063-022-06570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Premature birth is the leading cause of neonatal death and can cause major morbidity. Maximising the amount of maternal breastmilk given to very premature infants is important to improve outcomes, but this can be challenging for parents. Parents of infants receiving neonatal care also have high rates of anxiety and distress. There is growing evidence for the impact of maternal relaxation interventions on lactation, as well as mental health. The trial will assess whether a brief self-directed relaxation and visualisation intervention, recommended for use several times a day during expression of milk, improves lactation and mental health outcomes for mothers of very premature infants. Methods Multi-centre, randomised, controlled, unmasked, parallel-group trial with planned 132 participants who have experienced premature birth between 23 weeks and 31 weeks and 6 days of gestation and plan to express milk for at least 14 days. The primary outcome is the highest 24-h expressed milk yield recorded on any of day 4, day 14 or day 21 after birth. Secondary outcomes include exclusive breastmilk feeding at 36 weeks post-menstrual age and at 4 months after the estimated date of delivery, Spielberger State Trait Anxiety Index at day 21 and Post-traumatic stress Check List (for DSM 5) at day 21. Discussion Breastmilk feeding for premature infants is an important research priority, but there are few randomised controlled trials assessing interventions to help parents reach lactation goals in this challenging context. This trial will assess whether a no cost, easily scalable relaxation tool has a role in this setting. Given the lack of harm and potential for immediate dissemination, even a small benefit could have an important global impact. Trial registration ISRCTN16356650. Date assigned: 19/04/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06570-9.
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Affiliation(s)
- Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer L Bell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christina Cole
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frances O'Brien
- Newborn Care, John Radcliffe Hospital, Oxford University Hospitals NHS Trust & Faculty of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Rawn DFK, Dufresne G, Clément G, Fraser WD, Arbuckle TE. Perfluorinated alkyl substances in Canadian human milk as part of the Maternal-Infant Research on Environmental Chemicals (MIREC) study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 831:154888. [PMID: 35367260 DOI: 10.1016/j.scitotenv.2022.154888] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 05/27/2023]
Abstract
Perfluorinated alkyl substances (PFAS) were determined in human milk samples (n = 664) from participants in the Maternal-Infant Research on Environmental Chemicals (MIREC) study. ΣPFAS concentrations (sum of seven PFAS) ranged from 3.1 ng L-1 to 603 ng L-1, with a median concentration of 106 ng L-1 in the Canadian mothers' milk analyzed. These data comprise the first pan-Canadian dataset of PFAS in human milk. Perfluorooctanoic acid (PFOA) and linear perfluorooctanesulfonate (L-PFOS) were the dominant contributors to ΣPFAS in human milk samples. An inverse relationship between ΣPFAS concentrations and age was observed (Spearman correlation - 0.184). Primiparous women had elevated PFAS concentrations in milk relative to women who had children previously (p < 0.001). In contrast, the region of maternal birth did not influence ΣPFAS concentrations (p = 0.156). Although China and Norway have observed consistently detectable levels of perfluoroundecanoic acid (PFUdA) in human milk, PFAS with long carbon chains (n ≥ 11) were not present above method detection limits in Canadian human milk samples analyzed as part of the MIREC study. In conclusion, despite the presence of low levels of environmental contaminants in human milk, Health Canada supports breastfeeding due to the benefits to both infants and mothers.
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Affiliation(s)
- Dorothea F K Rawn
- Food Research Division, Bureau of Chemical Safety, Health Products and Food Branch, Health Canada, Sir Frederick Banting Research Centre, 251 Sir Frederick Banting Driveway, Address Locator: 2203C, Tunney's Pasture, Ottawa, ON K1A 0K9, Canada.
| | - Guy Dufresne
- Health Canada, Health Products Laboratory Program, Health Products Laboratory and Microbiology Laboratory Longueuil, 1001 Saint-Laurent Ouest, Longueuil, QC J4K 1C7, Canada
| | - Geneviève Clément
- Health Canada, Health Products Laboratory Program, Health Products Laboratory and Microbiology Laboratory Longueuil, 1001 Saint-Laurent Ouest, Longueuil, QC J4K 1C7, Canada
| | - William D Fraser
- CHU Sainte-Justine, Centre de recherche, Université de Montréal, Montréal, QC, Canada. Current Address: Centre hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Tye E Arbuckle
- Environmental Health Science and Research Bureau, Environmental and Radiation Health Sciences Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, 50 Colombine Driveway, Address Locator: 0801A, Tunney's Pasture, Ottawa, ON K1A 0K9, Canada
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Dai Y, Zhu L, Zhou Y, Wu Y, Chen D, Wang R, Wu L, Guo S, Gao L, Xu P, Wang Y, Dong S, Liu N, Wu Y, Chen H, Sun Y, Chen C, Zhang S. Incidence of retinopathy of prematurity treatment in extremely preterm infants in China. Paediatr Perinat Epidemiol 2022; 36:380-389. [PMID: 34467552 DOI: 10.1111/ppe.12810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) continues to be a major cause of visual impairment and blindness in premature infants and children. OBJECTIVES To investigate the incidence of severe ROP receiving treatment in extremely preterm (EP) infants in China over time. The risk factors for ROP treatment were also assessed. METHODS This was a multicentre retrospective study and a subanalysis of baseline data from the "Outcomes of EP infants in China 2010-2019" study. This study was conducted in 68 tertiary neonatal care centres from 31 provinces of China. Infants with a gestational age of 230 -276 weeks and admitted to a neonatal unit within the first 72 h of life between 2010 and 2019 were enrolled. Incidence of ROP was analysed in infants who survived to 32 weeks postmenstrual age and screened for ROP. Multivariable modified Poisson regression models were used to identify risk factors for ROP treatment. RESULTS Among 7295 eligible infants, 4701 (64.5%) survived to 32 weeks postmenstrual age and met ROP screening criteria. Of the 3756 infants who screened and with ROP data, 2320 (61.8%) developed ROP of any stage. The overall incidence of ROP treatment was 12.6%, decreasing from 45.5% at 23 weeks to 8.3% at 27 weeks. During the 10-year period, the incidence of ROP treatment did not change, although the incidence of any ROP increased over time. Independent risk factors associated with ROP treatment included lower gestational age, small for gestational age, multiple birth, severe intraventricular haemorrhage, patent ductus arteriosus and supplemental oxygen duration. CONCLUSIONS The incidence of EP infants receiving ROP treatment showed no change during this 10-year period in China. Prevention of prematurity and foetal growth restriction, judicious use of oxygen and reducing comorbidities are promising factors that may reduce the incidence of ROP needing treatment in these high-risk infants.
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Affiliation(s)
- Yi Dai
- Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Li Zhu
- Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Yequn Zhou
- Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Yanqiu Wu
- Yantai Yuhuangding Hospital, Yantai, China
| | - Dongmei Chen
- Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Ruiquan Wang
- Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Linlin Wu
- Xiamen Maternity and Child Health Hospital, Xiamen, China
| | - Shaoqing Guo
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | | | - Ping Xu
- Liaocheng People's Hospital, Liaocheng, China
| | - Yang Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shanshan Dong
- Jiujiang Maternity and Child Health Care Hospital, Jiujiang, China
| | - Ning Liu
- Jiujiang Maternity and Child Health Care Hospital, Jiujiang, China
| | - Yan Wu
- Chongqing Health Centre for Women and Children, Chongqing, China
| | - Haoming Chen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yumei Sun
- The Obstetrics and Gynecology Hospital of Dalian, Shanghai, China
| | - Chao Chen
- Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
| | - Shulian Zhang
- Children's Hospital of Fudan University, National Children's Medical Centre, Shanghai, China
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Laborie S, Abadie G, Denis A, Touzet S, Fischer Fumeaux CJ. A Positive Impact of an Observational Study on Breastfeeding Rates in Two Neonatal Intensive Care Units. Nutrients 2022; 14:nu14061145. [PMID: 35334802 PMCID: PMC8951536 DOI: 10.3390/nu14061145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/27/2023] Open
Abstract
We aimed to investigate whether the participation in an observational study on breastfeeding (Doal) modified breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). This bi-centric before-and-after study included neonates who were admitted during a 4-month period before and a 4-month period after the implementation of Doal. Breastfeeding intention and breastfeeding rates at discharge were compared between the two periods. The association between inclusion in Doal and breastfeeding at discharge was assessed among the infants fulfilling the inclusion criteria of Doal. The present study included 655 neonates. After adjustments, both breastfeeding (aOR 1.21, 95%CI [1.1; 1.4], p = 0.001) and exclusive breastfeeding (aOR 1.8, 95%CI [1.4; 2.3], p < 0.001) at discharge increased in the period after. Breastfeeding intention was higher in one center in the period after (79%) compared to before (59%, p = 0.019). Compared to the period before, neonates who were not included in Doal in the period after had a lower chance to be breastfed at discharge, whereas those included were more frequently exclusively breastfed. The participation in an observational study on breastfeeding was associated with an increase in breastfeeding outcomes in enrolling neonatal intensive care units (NICUs). Patients who are not included deserve attention as they are at risk to be disadvantaged regarding breastfeeding success.
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Affiliation(s)
- Sophie Laborie
- Service de Réanimation Néonatale et Néonatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Bron, France
- Correspondence: ; Tel.: +33-427855284
| | - Géraldine Abadie
- Réanimation Pédiatrique et Médecine Néonatale, CHU Félix Guyon, 97405 Saint Denis de la Réunion, France;
| | - Angélique Denis
- Laboratoire de Biométrie et Biologie Evolutive, UMR 5558, CNRS, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France;
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, UMR 5558, CNRS, 69100 Villeurbanne, France
| | - Sandrine Touzet
- Service de Recherche Clinique et Épidémiologique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
- Research on Healthcare Performance Lab, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Céline J. Fischer Fumeaux
- Department Mother-Woman-Child, Clinic of Neonatology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
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Strategies to Improve Mother's Own Milk Expression in Black and Hispanic Mothers of Premature Infants. Adv Neonatal Care 2022; 22:59-68. [PMID: 33756497 DOI: 10.1097/anc.0000000000000866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mother's own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants. PURPOSE A review of the literature was conducted to answer the clinical question: "What evidence-based strategies encourage and improve mother's own milk expression in Black and Hispanic mothers of premature infants?" METHODS/SEARCH STRATEGY Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7). FINDINGS/RESULTS Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area. IMPLICATIONS FOR PRACTICE Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice. IMPLICATIONS FOR RESEARCH Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.
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21
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Filippi L, Cammalleri M, Amato R, Ciantelli M, Pini A, Bagnoli P, Dal Monte M. Decoupling Oxygen Tension From Retinal Vascularization as a New Perspective for Management of Retinopathy of Prematurity. New Opportunities From β-adrenoceptors. Front Pharmacol 2022; 13:835771. [PMID: 35126166 PMCID: PMC8814365 DOI: 10.3389/fphar.2022.835771] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022] Open
Abstract
Retinopathy of prematurity (ROP) is an evolutive and potentially blinding eye disease that affects preterm newborns. Unfortunately, until now no conservative therapy of active ROP with proven efficacy is available. Although ROP is a multifactorial disease, premature exposition to oxygen concentrations higher than those intrauterine, represents the initial pathogenetic trigger. The increase of oxygenation in a retina still incompletely vascularized promotes the downregulation of proangiogenic factors and finally the interruption of vascularization (ischemic phase). However, the increasing metabolic requirement of the ischemic retina induces, over the following weeks, a progressive hypoxia that specularly increases the levels of proangiogenic factors finally leading to proliferative retinopathy (proliferative phase). Considering non-modifiable the coupling between oxygen levels and vascularization, so far, neonatologists and ophthalmologists have "played defense", meticulously searching the minimum necessary concentration of oxygen for individual newborns, refining their diagnostic ability, adopting a careful monitoring policy, ready to decisively intervene only in a very advanced stage of disease progression. However, recent advances have demonstrated the possibility to pharmacologically modulate the relationship between oxygen and vascularization, opening thus the perspective for new therapeutic or preventive opportunities. The perspective of a shift from a defensive towards an attack strategy is now at hand.
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Affiliation(s)
- Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Amato
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Alessandro Pini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paola Bagnoli
- Department of Biology, University of Pisa, Pisa, Italy
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22
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Hanford J, Mannebach K, Ohler A, Patten M, Pardalos J. Rates of Comorbidities in Very Low Birth Weight Infants Fed an Exclusive Human Milk Diet Versus a Bovine Supplemented Diet. Breastfeed Med 2021; 16:814-820. [PMID: 34415775 DOI: 10.1089/bfm.2020.0345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Our level III neonatal intensive care unit (NICU) implemented the use of an exclusive human milk diet (EHD) and sought to determine its effect on the severe co-morbidities of preterm infants as well as the potential cost-savings due to the anticipated reduction in these co-morbidities. Methods: A retrospective cohort study was completed to determine if an EHD statistically decreased the rate of co-morbidities including length of stay (LOS), days on total parental nutrition (TPN), rates of late onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP). Results: An EHD significantly decreased the odds of severe ROP (adjusted odds-ratio (aOR)=0.349; 95%CI [0.156, 0.739]; p=0.008) and late onset sepsis (aOR=0.323; 95%CI [0.123, 0.768]; p=0.014). Analysis of cost-effectiveness of an EHD relative to a BSD based on the incremental costs of these co-morbidities determined the net loss in direct hospital costs per patient were estimated to be $420 in 2016 US dollars; however, given the long-term health-care costs and non-pecuniary damages from the co-morbidities of severe ROP and sepsis this net loss appears negligible. Conclusion: This study found that an EHD significantly decreased the odds of severe ROP and late onset sepsis; though not significant, there was a positive trend in decreasing cases of medical NEC; our surgical NEC rates dropped to 0. The benefits of human milk are vital, and the costs are nominal.
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Affiliation(s)
- Jennifer Hanford
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Kimberly Mannebach
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Adrienne Ohler
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Michael Patten
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - John Pardalos
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
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23
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Wiechers C, Doll JN, Maas C, Gründler K, Büchner K, Poets CF, Franz AR. Enteral feeding advancement and growth until 5 years in extremely preterm infants. BMC Pediatr 2021; 21:420. [PMID: 34556084 PMCID: PMC8459503 DOI: 10.1186/s12887-021-02878-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background In-utero weight gain can be achieved in very preterm infants through rapid advancement of enteral feeds without increasing risk of necrotizing enterocolitis. There are concerns, however, that such rapid weight gain may lead to an increased childhood adiposity risk, although long-term data are sparse. Design This retrospective observational study included two well-characterized cohorts comprising 145 infants born at < 28 weeks or with < 1000 g birth weight. We investigated associations between advancing enteral feeding volumes in daily increments of 15–20 ml/kg (Cohort 1, n = 84, born in 2006/2007) vs. 25–30 ml/kg (Cohort 2, n = 61, born in 2010) and growth up to 5 years of age. Results There was no significant difference in anthropometric parameters post discharge to 5 years between both cohorts. Standard deviation score (SDS) weight and SDS BMI at the age of 5 years remained lower than in the reference population. SDS weight decreased from discharge to about 10–12 months postnatal age and returned to birth values by age 5 years. There was a catch-up for SDS length/height from discharge to 5 years; SDS head circumference decreased from birth to 5 years. Multiple regression analyses revealed that for all anthropometric parameters SDS at birth was the most important predictor for SDS at 5 years. Early parenteral protein intake may be another important factor, at least for head growth. Conclusions Growth was similar in both cohorts without benefit from more accelerated feeding advancement in cohort 2. In both cohorts, early enteral nutrition was associated with in-hospital weight gain as in utero, a drop in weight SDS post discharge and catch-up to birth SDS until age 5 years, remaining below the reference population. Length showed catch-up form discharge to 5 years, whereas head circumference progressively deviated from the reference population. Increased parenteral protein supplementation may be needed to accompany early enteral feeding advancements.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Jan-Niklas Doll
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Christoph Maas
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Kerstin Gründler
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Katja Büchner
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.
| | - Axel R Franz
- Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.,Center for Pediatric Clinical Studies, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany
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24
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Parker LA, Krueger C, Sullivan S, Mueller M. Demographic, Social, and Personal Factors Associated With Lactation Cessation by 6 Weeks in Mothers of Very Low Birth Weight Infants. J Hum Lact 2021; 37:511-520. [PMID: 33030992 DOI: 10.1177/0890334420940239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although mother's own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant. RESEARCH AIM To determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants. METHODS We used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation. RESULTS Participants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p = .019), Medicaid eligible (p = .009), less educated (p < .031), smoke (p = .002), provide less skin-to-skin care (p = .007), and to delay the decision to provide their milk to their infant (p = .007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation. CONCLUSION While the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother's own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population.This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013.
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25
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Dani C, Coviello C, Panin F, Frosini S, Costa S, Purcaro V, Lepore D, Vento G. Incidence and risk factors of retinopathy of prematurity in an Italian cohort of preterm infants. Ital J Pediatr 2021; 47:64. [PMID: 33712037 PMCID: PMC7953747 DOI: 10.1186/s13052-021-01011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Non-negligible differences in retinopathy of prematurity (ROP) and its risk factors between different neonatal intensive care units (NICUs) are reported. Our aim was to assess the incidence and risk factors for ROP development in a large cohort of very preterm infants who were assisted in two Italian NICUs. METHODS Preterm infants with gestational age between 23+ 0 and 29+ 6 weeks were stratified into subgroups of infants who developed ROP and those who did not; their clinical characteristics were compared with univariate and multivariable logistic regression analyses. RESULTS We studied a total of 178 infants of whom 67 (38%) developed ROP (stage 1: n = 12; stage 2: n = 41; stage 3: n = 14). Regression analysis demonstrated that maternal milk (OR 0.979, 95% Cl 0.961-0.998) decreased the risk of developing ROP, while intraventricular hemorrhage (IVH) (OR 2.055, 95% Cl 1.120-3.772) increased it. Moreover, maternal milk was found to decrease (OR 0.981, 95% Cl 0.964-0.997) the risk of ROP at discharge, while RBC transfusion increased it (OR 1.522, 95% Cl 1.208-1.916). CONCLUSIONS In our cohort the occurrence of ROP was similar to that previously reported. Strategies for promoting the use of mother's own milk, preventing IVH, and standardizing the approach to RBC transfusions could contribute to decreasing the risk of ROP in very preterm infants.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy.
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy
| | - Fiorenza Panin
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy
| | - Saverio Frosini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Simonetta Costa
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Velia Purcaro
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Domenico Lepore
- Department of Ophthalmology, Gemelli Foundation IRCSS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
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26
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Siswanto JE, Dijk PH, Bos AF, Sitorus RS, Adisasmita AC, Ronoatmodjo S, Sauer PJJ. How to prevent ROP in preterm infants in Indonesia? Health Sci Rep 2021; 4:e219. [PMID: 33490635 PMCID: PMC7813016 DOI: 10.1002/hsr2.219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/21/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIMS Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP. METHODS Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC. RESULTS Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91-95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis. DISCUSSION Preterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required. CONCLUSION Concerted action is needed to reduce the incidence of ROP in LMIC. "STOP - R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.
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Affiliation(s)
- Johanes Edy Siswanto
- Neonatology Working Group, Department of PediatricsHarapan Kita Women and Children HospitalJakartaIndonesia
- Faculty of MedicinePelita Harapan UniversityTangerangIndonesia
| | - Peter H. Dijk
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
| | - Arend F. Bos
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
| | - Rita S. Sitorus
- Department of OphthalmologyCipto Mangunkusumo HospitalJakartaIndonesia
| | - Asri C. Adisasmita
- Department of EpidemiologyUniversity of Indonesia, School of Public HealthDepokIndonesia
| | - Sudarto Ronoatmodjo
- Department of EpidemiologyUniversity of Indonesia, School of Public HealthDepokIndonesia
| | - Pieter J. J. Sauer
- Department of PediatricsBeatrix Children's Hospital, University Medical Center GroningenGroningenThe Netherlands
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Quitadamo PA, Palumbo G, Cianti L, Lurdo P, Gentile MA, Villani A. The Revolution of Breast Milk: The Multiple Role of Human Milk Banking between Evidence and Experience-A Narrative Review. Int J Pediatr 2021; 2021:6682516. [PMID: 33623528 PMCID: PMC7872774 DOI: 10.1155/2021/6682516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 02/05/2023] Open
Abstract
The review recalls the importance of breast milk and deepens the theme of human milk banking, a virtuous reality that is expanding all over the world but is still little known. In the last 15 years, modern biological technologies have crystallized the concept of uniqueness and irreproducibility of human milk, by establishing three new principles: first: human milk: a "life-saving" drug; second: human milk: the best food for preterm infants; and third: human milk: the main component of premature infant care. Our experience teaches us that human milk banking plays many roles that need to be known and shared.
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Affiliation(s)
- Pasqua Anna Quitadamo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppina Palumbo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Liliana Cianti
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Paola Lurdo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Maria Assunta Gentile
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Villani
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
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28
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Raghuveer TS, Zackula R. Strategies to Prevent Severe Retinopathy of Prematurity: A 2020 Update and Meta-analysis. Neoreviews 2021; 21:e249-e263. [PMID: 32238487 DOI: 10.1542/neo.21-4-e249] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence of retinopathy of prematurity (ROP) is showing an increasing trend in the United States. This may be because of increasing survival rates among extremely preterm infants (<25 weeks' gestation) and targeting higher oxygen saturation. Five randomized clinical trials of low versus high oxygen saturation target ranges found increased mortality in the low oxygen saturation target group and an increased incidence of ROP in the high oxygen saturation target group. The American Academy of Pediatrics recommends using an oxygen saturation target range of 90% to 95% in extremely low-birthweight infants. The change of practice to target this higher oxygen saturation range, from admission until discharge, may be contributing to the increasing incidence of ROP in extremely preterm infants. To decrease the incidence of ROP without increasing mortality, 2 new cohort trials suggest gradually increasing oxygen saturation targets as preterm infants mature. There is evidence that human milk, vitamin A, and omega-3 fatty acids can help, in addition to continuous oxygen saturation monitoring, to decrease the risk of ROP. We review this literature and provide a meta-analysis to evaluate the evidence.
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Affiliation(s)
| | - R Zackula
- Research, University of Kansas School of Medicine at Wichita, Wichita, KS
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29
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Bramer S, Boyle R, Weaver G, Shenker N. Use of donor human milk in nonhospitalized infants: An infant growth study. MATERNAL AND CHILD NUTRITION 2021; 17:e13128. [PMID: 33404169 PMCID: PMC7988867 DOI: 10.1111/mcn.13128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
When mother's own milk (MOM) is unavailable or insufficient, donor human milk (DHM) is recommended as the next best alternative for low birthweight infants. DHM use for healthy, term infants is increasing, but evidence for growth and tolerability is limited. This retrospective study evaluated growth in term infants in the community who received DHM from a UK milk bank. Mothers of infants receiving DHM between 2017 and 2019 were contacted (n = 49), and 31 (63.2%) agreed to participate. Fourteen infants received DHM as a supplement to other feeds (MOM and/or infant formula) and 17 were exclusively fed DHM where breastfeeding was impossible (range: 3–6 weeks). Growth was assessed by deriving z‐scores using the WHO standard for infant growth and compared with 200 exclusively breastfed infants. Multivariate regression analysis revealed no feeding method‐specific association between z‐score and age, nor between weight and age, suggesting that z‐scores and growth velocity were not affected by feeding exclusive MOM, supplemental DHM or exclusive DHM. DHM was well‐tolerated with no adverse events that led to early cessation. After receiving supplemental DHM group, 63% of infants whose mothers had no physical barrier to breastfeeding (5/8 infants) were exclusively breastfed. This novel study reports adequate growth outcomes of healthy nonhospitalized infants receiving DHM, either as the sole milk source or supplement. Prospective studies are needed to confirm whether DHM is a suitable feeding alternative for term infants in the community, optimal durations, as well as the impact of DHM availability on breastfeeding rates and maternal mental health. DHM recipients were compared with the who infant growth standard (World Health Organization, 2020) by deriving z‐scores. The WHO Anthro Macro (World Health Organization, 2011 ) was used to calculate weight‐for‐age, length‐for‐age and head circumference‐for‐age z‐scores; z‐scores are the standard deviation of an infant's anthropometric measurements when compared with the WHO standard for infant growth and are gender and age specific.
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Affiliation(s)
- Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, UK
| | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, UK
| | - Gillian Weaver
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK
| | - Natalie Shenker
- The Human Milk Foundation, Daniel Hall Building, Rothamsted Institute, Herts, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Dai Y, Zhu L, Zhou Y, Chen C, Zhang S. Ten-Year Trend of Retinopathy of Prematurity Among Extremely Preterm Infants in One Neonatal Intensive Care Unit in China. Front Pediatr 2021; 9:717090. [PMID: 34540768 PMCID: PMC8446679 DOI: 10.3389/fped.2021.717090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Extremely preterm (EP) infants are at the highest risk of retinopathy of prematurity (ROP). With more EP infants survived in China, recent data of ROP is lacking. The aim of the study is to report the trend of incidence of ROP among EP infants in a large neonatal intensive care unit in China over the past 10-year period, in relation with the overall survival rate and the change of oxygen saturation targets. Methods: This retrospective cohort study enrolled all EP infants born before 28 weeks' gestation and admitted to one of the largest tertiary neonatal intensive care units in China from 2010 to 2019. Data were compared between two time periods according to different oxygen saturation targets: 2010-2014 (P1) with low saturation target and 2015-2019 (P2) with higher target. Results: Of 630 EP infants admitted during the 10 years, 447 (71.0%) infants survived to discharge. The survival rate increased significantly from 61.6% in P1 to 75.8% in P2 (P < 0.05). Of the 472 infants who had ROP data, 318 (67.4%) developed ROP of any stage, 67 (14.2%) developed severe ROP, and 44 (9.3%) received treatment. The incidence of any ROP increased significantly from 51.7% in P1 to 74.3% in P2 (P < 0.05). The incidence of severe ROP increased from 11.0% in P1 to 15.6% in P2, and ROP treatment increased from 6.9% in P1 to 10.4% in P2, but neither reached statistical significance (both P > 0.05). Conclusions: We observed an increasing trend in the incidence of ROP across the 10-year period in one of the largest neonatal care units in China. The increased survival rate and the use of high-target oxygen saturation in the later period may partly explain this trend. Further investigations are needed to improve the care practices and to reduce the incidence of severe ROP.
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Affiliation(s)
- Yi Dai
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Zhu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yequn Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Shulian Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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Buldur E, Yalcin Baltaci N, Terek D, Yalaz M, Altun Koroglu O, Akisu M, Kultursay N. Comparison of the Finger Feeding Method Versus Syringe Feeding Method in Supporting Sucking Skills of Preterm Babies. Breastfeed Med 2020; 15:703-708. [PMID: 32915053 DOI: 10.1089/bfm.2020.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim: The aim of this study is to compare the efficiency of a new method called "finger feeding" with a well-known technique called syringe feeding for improving sucking skills and accelerating transition to breastfeeding in preterm infants. Materials and Methods: Totally 70 babies were included in this prospective randomized controlled study. Finger feeding method was applied in Group 1 (n = 35) and syringe feeding method was applied in Group 2 (n = 35). The COMFORTneo scale (CnS), oxygen saturation, pulse, respiratory rate, body temperature, amount of breast milk taken, and vomiting data were recorded before and after both applications. Hospitalization period and time elapsed for complete transition from both methods to breastfeeding were also recorded. Results: There was no statistical difference for birth weights, mean gestational age, and vital signs recorded before and after feeding between two groups. Predicted comfort and distress scores of Group 1 determined by the CnS were significantly lower than those of Group 2. This means that babies in the finger feeding group had better comfort than the those in Group 2 (p = 0.000). Time passed for transition to breastfeeding was significantly shorter than that in Group 2 (19.4 ± 15.0 days versus 29.7 ± 10.2 days, p = 0.000). Group 1 had lower amount of food leakage while feeding and their average weight gain at the end of 10th day was significantly higher (322.1 ± 82.3 g versus 252 ± 108.4 g, p = 0.004). They also were discharged earlier than Group 2 (25.8 ± 17.4 days versus 35.9 ± 13.0 days, p = 0.001). Conclusion: Finger feeding method is an effective way for increasing sucking abilities, accelerating transition to breastfeeding, and shortens duration of hospitalization in preterm infants.
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Affiliation(s)
- Emel Buldur
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Nalan Yalcin Baltaci
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Demet Terek
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Mehmet Yalaz
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ozge Altun Koroglu
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Mete Akisu
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Nilgun Kultursay
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, Izmir, Turkey
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Johnson TJ, Berenz A, Wicks J, Esquerra-Zwiers A, Sulo KS, Gross ME, Szotek J, Meier P, Patel AL. The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit. J Pediatr 2020; 224:57-65.e4. [PMID: 32682581 PMCID: PMC7484385 DOI: 10.1016/j.jpeds.2020.04.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/17/2020] [Accepted: 04/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of mother's own milk supplemented with donor milk vs mother's own milk supplemented with formula for infants of very low birth weight in the neonatal intensive care unit (NICU). STUDY DESIGN A retrospective analysis of 319 infants with very low birth weight born before (January 2011-December 2012, mother's own milk + formula, n = 150) and after (April 2013-March 2015, mother's own milk + donor milk, n = 169) a donor milk program was implemented in the NICU. Data were retrieved from a prospectively collected research database, the hospital's electronic medical record, and the hospital's cost accounting system. Costs included feedings and other NICU costs incurred by the hospital. A generalized linear regression model was constructed to evaluate the impact of feeding era on NICU total costs, controlling for neonatal and sociodemographic risk factors and morbidities. An incremental cost-effectiveness ratio was calculated for each morbidity that differed significantly between feeding eras. RESULTS Infants receiving mother's own milk + donor milk had a lower incidence of necrotizing enterocolitis (NEC) than infants receiving mother's own milk + formula (1.8% vs 6.0%, P = .048). Total (hospital + feeding) median costs (2016 USD) were $169 555 for mother's own milk + donor milk and $185 740 for mother's own milk + formula (P = .331), with median feeding costs of $1317 and $936, respectively (P < .001). Mother's own milk + donor milk was associated with $15 555 lower costs per infant (P = .045) and saved $1812 per percentage point decrease in NEC incidence. CONCLUSIONS The additional cost of a donor milk program was small compared with the cost of a NICU hospitalization. After its introduction, the NEC incidence was significantly lower with small cost savings per case. We speculate that NICUs with greater NEC rates may have greater cost savings.
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Affiliation(s)
- Tricia J. Johnson
- Department of Health Systems Management, Rush University, Chicago, IL, USA
| | - Andrew Berenz
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Wicks
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Kelly S. Sulo
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| | - Megan E. Gross
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
| | | | - Paula Meier
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA,College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Aloka L. Patel
- Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL, USA
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Jędrzejczak J, Wilińska M, Kamińska E, Lauterbach R, Helwich E, Jackowska T, Nagańska E, Jacyna N, Majkowska-Zwolińska B. A position paper on breastfeeding by women with epilepsy – working group report. JOURNAL OF EPILEPTOLOGY 2020. [DOI: 10.21307/jepil-2020-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Malinowska-Pańczyk E. Can high hydrostatic pressure processing be the best way to preserve human milk? Trends Food Sci Technol 2020. [DOI: 10.1016/j.tifs.2020.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Trinta VDO, Padilha PDC, Petronilho S, Santelli RE, Braz BF, Freire AS, Saunders C, Rocha HFD, Sanz-Medel A, Fernández-Sánchez ML. Total metal content and chemical speciation analysis of iron, copper, zinc and iodine in human breast milk using high-performance liquid chromatography separation and inductively coupled plasma mass spectrometry detection. Food Chem 2020; 326:126978. [PMID: 32413760 DOI: 10.1016/j.foodchem.2020.126978] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 02/08/2023]
Abstract
The aim of this research was to quantify essential trace elements (iron, copper, zinc and iodine) and establish their speciation in human milk. Both the element and the species are important in new-born nutrition. Colostrum, and transitional and mature milks (25) were collected from 18 mothers of pre-term or full-term infants. Concentrations of the target elements were determined using ICP-MS. For speciation, HPLC coupled to ICP-MS was employed. Total contents of the micronutrients varied in mothers of pre-term (Fe = 0.997, Cu = 0.506, Zn = 4.15 and I = 0.458 mg L-1) and mothers of full-term (Fe = 0.733, Cu = 0.234, Zn = 2.91 and I = 0.255 mg L-1) infants. Fe, Cu and Zn were associated with biomolecules with high molecular mass compounds, such as immunoglobulins, albumin and lactoferrin whilst iodine was only found as iodide.
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Affiliation(s)
- Vânia de Oliveira Trinta
- Maternity School of the Federal University of Rio de Janeiro, Professional Master's Program in Perinatal Health, Rua das Laranjeiras, 180, CEP 22.240-000 Rio de Janeiro, Brazil
| | - Patrícia de Carvalho Padilha
- Maternity School of the Federal University of Rio de Janeiro, Professional Master's Program in Perinatal Health, Rua das Laranjeiras, 180, CEP 22.240-000 Rio de Janeiro, Brazil; Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, CCS, Bloco J, 2° andar, Cidade Universitária, CEP 21941-902 Rio de Janeiro, Brazil
| | - Sonaly Petronilho
- Maternity School of the Federal University of Rio de Janeiro, Professional Master's Program in Perinatal Health, Rua das Laranjeiras, 180, CEP 22.240-000 Rio de Janeiro, Brazil
| | - Ricardo Erthal Santelli
- Analytical Chemistry Department, Federal University of Rio de Janeiro, Av. Athos da Silveira Ramos 149, CT, Bloco A, 5° andar, Cidade Universitária, CEP 21941-909 Rio de Janeiro, Brazil; National Institute of Science and Technology for Bioanalytics - INCTBio, CEP 13083-970 Campinas, Brazil.
| | - Bernardo Ferreira Braz
- Analytical Chemistry Department, Federal University of Rio de Janeiro, Av. Athos da Silveira Ramos 149, CT, Bloco A, 5° andar, Cidade Universitária, CEP 21941-909 Rio de Janeiro, Brazil; National Institute of Science and Technology for Bioanalytics - INCTBio, CEP 13083-970 Campinas, Brazil
| | - Aline Soares Freire
- Analytical Chemistry Department, Federal University of Rio de Janeiro, Av. Athos da Silveira Ramos 149, CT, Bloco A, 5° andar, Cidade Universitária, CEP 21941-909 Rio de Janeiro, Brazil; National Institute of Science and Technology for Bioanalytics - INCTBio, CEP 13083-970 Campinas, Brazil
| | - Cláudia Saunders
- Maternity School of the Federal University of Rio de Janeiro, Professional Master's Program in Perinatal Health, Rua das Laranjeiras, 180, CEP 22.240-000 Rio de Janeiro, Brazil; Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, CCS, Bloco J, 2° andar, Cidade Universitária, CEP 21941-902 Rio de Janeiro, Brazil
| | - Hélio Fernandes da Rocha
- Medical School, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, CCS, Bloco K, 2° andar, Cidade Universitária, CEP 21941-902 Rio de Janeiro, Brazil
| | - Alfredo Sanz-Medel
- Physical and Analytical Chemistry Department, Faculty of Chemistry, University of Oviedo, Oviedo, Spain
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Fengler J, Heckmann M, Lange A, Kramer A, Flessa S. Cost analysis showed that feeding preterm infants with donor human milk was significantly more expensive than mother's milk or formula. Acta Paediatr 2020; 109:959-966. [PMID: 31705551 DOI: 10.1111/apa.15087] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/29/2019] [Accepted: 11/07/2019] [Indexed: 12/25/2022]
Abstract
AIM This study analysed the comparative cost of feeding donor human milk to preterm infants compared to mother's own milk and formula. METHODS A document and process analysis and a time measurement study were carried out at the milk bank of the Level 1 Perinatal Center of the University Hospital of Greifswald, Germany, from April to June 2017. The cost analysis data were provided by the University's financial department. RESULTS The total cost per year was €92 085.02 for 300 litres of donor human milk: 27% of this was material costs, 51% was personnel costs, and 22% was other overheads. The average cost per litre was €306.95, and staff time was 492 minutes per litre. The total marginal cost for each additional litre of donor human milk, formula or unpasteurised mother´s milk was €82.88, €10.28 and €38.42, respectively. Pasteurising a litre of donor milk cost €3.51. CONCLUSION Providing preterm infants with donor milk was much more expensive than using formula or mother's own milk, but the cost of pasteurisation was minimal.
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Affiliation(s)
- Josefine Fengler
- Department of Health Care Management Faculty of Law and Economics University of Greifswald Greifswald Germany
| | - Matthias Heckmann
- Department of Neonatology & Paediatric Intensive Care Ferdinand‐Sauerbruchstrasse University Medicine Greifswald Greifswald Germany
| | - Anja Lange
- Department of Neonatology & Paediatric Intensive Care Ferdinand‐Sauerbruchstrasse University Medicine Greifswald Greifswald Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine University Medicine Greifswald Greifswald Germany
| | - Steffen Flessa
- Department of Health Care Management Faculty of Law and Economics University of Greifswald Greifswald Germany
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Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, del Rey Hurtado de Mendoza B, Iriondo Sanz M, Iglesias-Platas I. Reply: "It is Time for a Universal Nutrition Policy in Very Preterm Neonates during the Neonatal Period? Comment on: Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants Nutrients 2019, 11, 2772". Nutrients 2020; 12:E983. [PMID: 32252477 PMCID: PMC7230857 DOI: 10.3390/nu12040983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
We would like to thank Gounaris et al [...].
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Affiliation(s)
- Montserrat Izquierdo Renau
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Victoria Aldecoa-Bilbao
- Neonatology Department, Hospital Clinic, Universidad de Barcelona, BCNatal, 08028 Barcelona, Spain;
| | - Carla Balcells Esponera
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Beatriz del Rey Hurtado de Mendoza
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Martin Iriondo Sanz
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
| | - Isabel Iglesias-Platas
- Neonatology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, BCNatal, Esplugues de Llobregat, 08950 Barcelona, Spain; (C.B.E.); (B.d.R.H.d.M.); (M.I.S.); (I.I.-P.)
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Nutritional composition of donor human milk according to lactation period. NUTR HOSP 2020; 37:1118-1122. [DOI: 10.20960/nh.03219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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El-Khuffash A, Jain A, Lewandowski AJ, Levy PT. Preventing disease in the 21st century: early breast milk exposure and later cardiovascular health in premature infants. Pediatr Res 2020; 87:385-390. [PMID: 31666687 DOI: 10.1038/s41390-019-0648-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/31/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022]
Abstract
Cardiovascular health of premature infants reaching early adulthood is an area of ongoing research. There is emerging evidence delineating the challenges faced by those individuals. Young adults born premature demonstrate a unique cardiac phenotype characterized by reduced biventricular volume, relatively lower systolic and diastolic function, and a disproportionate increase in muscle mass. This may clinically manifest by an increased risk of cardiovascular incidents, hypertension, and reduced exercise tolerance. Those consequences appear to result from early postnatal cardiac remodeling due to premature birth and associated co-morbidities. Recent evidence suggests that early exposure to breast milk slows down or even arrests those pathophysiological changes, thereby mitigating the long-term adverse effects of premature birth on cardiovascular health. In this review article, we discuss the role of breast milk in preventing early adulthood cardiovascular disease in infants born premature. We explore the emerging evidence and examine the possible mechanistic pathways mediating this phenomenon. Furthermore, we aim to demonstrate the vital role of early breast milk exposure in preventing cardiovascular disease in preterm infants.
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Affiliation(s)
- Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital and School of Medicine (Pediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Amish Jain
- Department of Paediatrics, University of Toronto and and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
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李 秀, 吴 艳, 钟 晓, 王 敏, 黄 利. [Breastfeeding promotion strategies study on preterm infants in the neonatal intensive care unit]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:711-715. [PMID: 31420627 PMCID: PMC7433505 DOI: 10.19723/j.issn.1671-167x.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the effect of breastfeeding promotion strategies on neonatal clinical outcomes of preterm infants during hospitalization in the neonatal intensive care unit (NICU). METHODS We developed breastfeeding promotion strategies, including the establishment of a multidisciplinary breastfeeding steering team, breastfeeding support of families and society, family-integrated care, kangaroo mother care, donor human milk bank, and so on. Preterm infants meeting the inclusion standard, less than 32 weeks gestational age, who were admitted to NICU from November 2015 to February 2017 were enrolled, and the eligible infants were divided into two groups (control group and intervention group) before and after policy implementation. The data of preterm infants including breastfeeding related outcomes (time to initiation of enteral feeding, time to initiation of breastfeeding, time to achieve full breastfeeding, time to achieve full enteral feeding and rate of breastfeeding), growth (extrauterine growth restriction) and complications were compared between the two groups. RESULTS One hundred and twenty-three preterm infants were enrolled, including 61 in the control group and 62 in the intervention group. There were no significant differences in gender, gestational age, birth weight, intrauterine growth retardation (IUGR) and admission disease status between the two groups (P>0.05). Compared with the control group, there were significantly earlier time to initiation of enteral feeding [15.37 (10.00, 22.13) h vs. 20.25 (12.88, 26.33) h, P<0.01], time to achieve full breastfeeding [91.00 (69.75, 103.00) h vs. 94.00 (80.37, 118.75) h, P=0.04], and time to achieve full enteral feeding [12 (11, 15) d vs. 14 (12, 18) d, P<0.01] in the intervention group. Otherwise, there were no significant differences in time to initiation of breastfeeding, hospital stay, extrauterine growth restriction (EUGR) occurance rate of weight, the rate of breastfeeding, motality, and the incidence of complications including feeding intolerance, neonatal necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) (P>0.05). CONCLUSION The breastfeeding promotion strategie was a quality improvement of ordinary breastfeeding protocol. It had significantly reduced time to initiation of enteral feeding, time to achieve full breastfeeding and time to achieve full enteral feeding for preterm infants in NICU. Further research is needed to confirm whether the strategies can improve the breastfeeding rate and reduce the occurrence of the complications, such as NEC, BPD, and ROP.
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Affiliation(s)
- 秀兰 李
- />重庆市妇幼保健院新生儿科, 重庆 401147Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - 艳 吴
- />重庆市妇幼保健院新生儿科, 重庆 401147Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - 晓云 钟
- />重庆市妇幼保健院新生儿科, 重庆 401147Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - 敏 王
- />重庆市妇幼保健院新生儿科, 重庆 401147Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
| | - 利 黄
- />重庆市妇幼保健院新生儿科, 重庆 401147Department of Neonatology, Chongqing Health Center for Women and Children, Chongqing 401147, China
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Cañizo Vázquez D, Salas García S, Izquierdo Renau M, Iglesias-Platas I. Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding. Nutrients 2019; 11:E1895. [PMID: 31416157 PMCID: PMC6722966 DOI: 10.3390/nu11081895] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022] Open
Abstract
Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother's milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.
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Affiliation(s)
- Débora Cañizo Vázquez
- Neonatology Department, Hospital Sant Joan de Déu, Universidad de Barcelona, BCNatal, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Sandra Salas García
- Neonatology Department, Hospital General Universitari Castelló, 12004 Castelló de la Plana, Spain.
| | - Montserrat Izquierdo Renau
- Neonatology Department, Hospital Sant Joan de Déu, Universidad de Barcelona, BCNatal, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Isabel Iglesias-Platas
- Neonatology Department, Hospital Sant Joan de Déu, Universidad de Barcelona, BCNatal, 08950 Esplugues de Llobregat, Barcelona, Spain
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Parker LA, Cacho N, Engelmann C, Benedict J, Wymer S, Michael W, Neu J. Consumption of Mother's Own Milk by Infants Born Extremely Preterm Following Implementation of a Donor Human Milk Program: A Retrospective Cohort Study. J Pediatr 2019; 211:33-38. [PMID: 31060805 DOI: 10.1016/j.jpeds.2019.03.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare mothers' own milk (MOM) consumption by infants born extremely preterm before and after implementation of a donor human milk (DHM) program and determine healthcare provider's knowledge and practices regarding DHM. STUDY DESIGN One hundred fifty-seven infants born at <30 weeks of gestation were enrolled during 3 time-periods. Group 1: before DHM program implementation, Group 2: the year following implementation, and Group 3: the second year after implementation. The proportion of feeds consisting of MOM for 6 weeks following birth was analyzed using a generalized linear mixed model. The study's second phase surveyed healthcare providers regarding knowledge and practices concerning DHM. RESULTS Group 1 consumed feeds with a greater proportion of MOM than Group 3 during weeks 1 (P < .001) and 3 (P = .007) and more than both Group 2 (P = .033) and 3 (P = .021) in week 4. During the first 14 days, Group 1 consumed feeds with 23.6% more MOM than Group 3 (P = .002) and had a greater odds of consuming feeds with > 90% MOM (P < .001) than Group 3. During days 1-28, Group 1 consumed feeds with 22% more MOM than Group 3 (P = .003) and had greater odds of consuming feeds with >90% MOM than Group 2 (P = .020) and 3 (P = .004). Knowledge regarding DHM was inconsistent among providers and they were unlikely to communicate potential risks and benefits of DHM to mothers. CONCLUSIONS Following implementation of a DHM program, MOM consumption decreased over 2 years. Strategies focused on lactation success are necessary to increase MOM consumption.
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Affiliation(s)
| | - Nicole Cacho
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Clara Engelmann
- Patient Revenue Management Organization, Duke University Health System, Durham, NC
| | | | - Susan Wymer
- College of Nursing, University of Florida, Gainesville, FL
| | - Weaver Michael
- College of Nursing, University of Florida, Gainesville, FL
| | - Josef Neu
- Department of Pediatrics, University of Florida, Gainesville, FL
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Hilditch C, Howes A, Dempster N, Keir A. What evidence-based strategies have been shown to improve breastfeeding rates in preterm infants? J Paediatr Child Health 2019; 55:907-914. [PMID: 31228328 DOI: 10.1111/jpc.14551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 12/01/2022]
Abstract
Breast milk is the preferred form of nutrition for all infants and has been shown to reduce morbidity and improve health outcomes in preterm infants. However, mothers of preterm infants face many challenges initiating and sustaining breastfeeding within the neonatal unit. This scoping review examines evidence-based practices which aim to improve breastfeeding rates in preterm infants at the time of hospital discharge. A literature review identified 17 articles which are included in this review. Supporting evidence was found for the implementation of kangaroo mother care and/or skin-to-skin care, peer counsellors, provision of oropharyngeal colostrum in early infancy and use of donor human milk banks. However, overall it is apparent that high quality research including systematic review and data synthesis in the form of meta-analysis is required in this area to reach sound conclusions regarding recommendations of different interventions. This scoping review provides an important foundation for further research into this area.
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Affiliation(s)
- Cathie Hilditch
- Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Alexander Howes
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Natalie Dempster
- Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
| | - Amy Keir
- Healthy Mothers, Babies and Children Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, South Australia, Australia
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Villamor-Martínez E, Pierro M, Cavallaro G, Mosca F, Villamor E. Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Front Pediatr 2019; 7:224. [PMID: 31275904 PMCID: PMC6593284 DOI: 10.3389/fped.2019.00224] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 05/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Bronchopulmonary dysplasia (BPD) is the most common complication of very preterm birth and can lead to lifelong health consequences. Optimal nutrition is a cornerstone in the prevention and treatment of BPD. In very preterm infants, mother's own milk (MOM) feeding is associated with lower risks of necrotizing enterocolitis, retinopathy of prematurity, and sepsis. Although several studies have shown that MOM may protect against BPD, a systematic analysis of the evidence has not been performed to date. Methods: A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE, from their inception to 1 December 2017. Longitudinal studies comparing the incidence of BPD in preterm infants fed with exclusive MOM, MOM supplemented with preterm formula (PF), and/or exclusively fed with PF were selected. A random-effects model was used to calculate the Mantel Haenszel risk ratio (RR) and 95% confidence interval (CI). Results: Fifteen studies met the inclusion criteria (4,984 infants, 1,416 BPD cases). Use of exclusive MOM feedings was associated with a significant reduction in the risk of BPD (RR 0.74, 95% CI 0.57-0.96, 5 studies). In contrast, meta-analysis could not demonstrate a significant effect on BPD risk when infants fed with more than 50% MOM were compared with infants fed with <50% MOM (RR 0.98, 95% CI 0.77-1.23, 10 studies) or when infants fed with MOM supplemented with PF were compared with infants fed with exclusive PF (RR 1.00, 95% CI 0.78-1.27, 6 studies). Meta-regression showed that differences in gestational age were a significant confounder of the effect of MOM. Conclusion: To our knowledge, this is the first systematic review and meta-analysis that specifically evaluates the role of MOM on BPD. Our data indicate that MOM may reduce the incidence of BPD when used as an exclusive diet, but this result needs to be interpreted with caution. We did not find the same difference in analyses with other dosages of MOM. Further studies adequately powered to detect changes in BPD rates and that adjust for confounders are needed to confirm the beneficial effects of MOM on BPD.
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Affiliation(s)
- Eduardo Villamor-Martínez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Maria Pierro
- UOC TIN e Neonatologia, Dipartimento Salute Mamma e Bambino, Fondazione Poliambulanza, Brescia, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
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Affiliation(s)
- Sergio Verd
- Department of Primary Care Balearic Health Authority Palma de Mallorca Spain
| | - Jaume Ponce‐Taylor
- Department of Primary Care Balearic Health Authority Palma de Mallorca Spain
| | - Gemma Ginovart
- Neonatal Unit Department of Paediatrics Hospital de la Santa Creu i Sant Pau Barcelona Spain
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Altimier L, Phillips R. Neuroprotective Care of Extremely Preterm Infants in the First 72 Hours After Birth. Crit Care Nurs Clin North Am 2019; 30:563-583. [PMID: 30447814 DOI: 10.1016/j.cnc.2018.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Birth at extremely low gestational ages presents a significant threat to infants' survival, health, development, and future well-being. After birth, a critical period of brain development must continue outside the womb. Neuro-supportive and neuroprotective family centered developmental care for and standardized care practices for extremely preterm infants have been shown to improve outcomes. Neuroprotective interventions must include a focus on the emotional connections of infants and their families. Being in skin-to-skin contact with the mother is the developmentally expected environment for all mammals and is especially important for supporting physiologic stability and neurodevelopment of preterm infants.
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Affiliation(s)
- Leslie Altimier
- Northeastern University, School of Nursing in the Bouvé College of Health Sciences, 360 Huntington Avenue, Boston, MA 02115, USA; Philips HealthTech, Cambridge, MA, USA.
| | - Raylene Phillips
- Loma Linda University School of Medicine, Department of Pediatrics, Division of Neonatology, Loma Linda University Children's Hospital, 11175 Campus Street, CP 11121 Loma Linda, CA 92354, USA; Loma Linda University Medical Center-Murrieta, 28062 Baxtor Road, Murrieta, CA 92563, USA
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Huang J, Zhang L, Tang J, Shi J, Qu Y, Xiong T, Mu D. Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2019; 104:F128-F136. [PMID: 29907614 DOI: 10.1136/archdischild-2017-314205] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants. DESIGN We searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study. RESULT A total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance. CONCLUSION Both exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.
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Affiliation(s)
- Jinglan Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jun Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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Muneer A, Bari A, Naveed S, Ali AS. Is human milk feeding protective for Retinopathy of Prematurity? Pak J Med Sci 2018; 34:1534-1538. [PMID: 30559818 PMCID: PMC6290239 DOI: 10.12669/pjms.346.15799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To find the association between breast milk feeding with retinopathy of prematurity (ROP) in preterm infants. Methods: This was a cross sectional study to examine the effects of breast milk feeding on ROP. Premature newborns below 34 weeks from neonatal unit retinopathy of prematurity program during the years 2015 to 2017 of The Lahore General Hospital were included. We recorded the gestational age, birth weight, presence of ROP and the type of feeding (breastfeeding vs. formula milk). Results: Out of 428 preterm babies 210 (49%) were males. More babies were between 32-34 weeks of gestation 229 (53.5%) as compared to < 32 weeks 199 (46.5%). Among all 428 preterm infants 19(4.4%) developed ROP. Majority 13 (68.4%) who developed ROP were <32 weeks of gestation (p=0.042). The mean birth weight of infants without ROP was 1.51± 0.36 kg (95%CI; 1.47-1.55), while it was 1.36 ± 0.29 kg (95%CI; 1.22-1.50) with ROP and all who developed ROP were < 2kg. The estimated odds ratio of developing ROP for breast fed versus top feeding was (ORs: 0.571, 95% CI; 0.222- 1.489). There was a trend toward lower incidence of ROP in the group of newborns who received breast-feeding (36.8%) as compared to top feeding (63.2%) but almost similar percentage who didn’t develop ROP were breast fed or top fed with statistically insignificant results (p= 0.24). Conclusions: Slightly lesser percentage of preterm babies who were breast fed developed retinopathy of prematurity.
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Affiliation(s)
- Ayesha Muneer
- Dr. Ayesha Muneer, DCH, F.C.P.S. (Pediatric Medicine), Assistant Professor, Pediatric Medicine, The Lahore General Hospital, Lahore, Pakistan
| | - Attia Bari
- Dr. Attia Bari, MCPS, DCH, F.C.P.S. (Pediatric Medicine), MHPE. Associate Professor, Paediatric Medicine, The Children's Hospital Lahore, Pakistan
| | - Summaira Naveed
- Dr. Summaira Naveed, F.C.P.S. (Pediatric Medicine), Assistant Professor, Pediatric Medicine, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Agha Shabbir Ali
- Prof. Agha Shabbir Ali, MCPS, F.C.P.S. (Paediatric Medicine) Professor of Pediatric Medicine, The Lahore General Hospital, Lahore, Pakistan
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